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'PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OTVNIR BU ILI}ER DI]LCA RA'I'ION
<br />I hcr.hy dmm x.a.r leh.lly oa pgjury lh.r I @ cr.mrr fmm tlt (nt racroB License tas' lbr rhc Iolb*ins re,$n (S.c 701 1.5
<br />Busi.ess .nd Prof€$ion Codef Any cny.r Counly whrch ..qutd r l.nnil to coosrucr. olrs. imnrov., &mlirh or Enatr anv
<br />srrucllr.. Drhr ro ir3 iaunncc, als .equircs rtc mpllcmr for $ch rm'n b [k . sign.{ starcft rhlr h. or .lE is lic.n<d Nrsad
<br />16 rh. pmrisions ofrh. Conlr,.di Lic.nsed hs (chilrcr 9, (.omnErcr8 wrh sccrion 70(n olDiYnt,.I ofrnc Bu$n8c 2nd
<br />Pofcssio.sCod.lorlhal heorsh. is eruqi rh.Ei.n.nd lheblrr firrhcall.g.d ex.mplion. AnyliolarionolsedrnT0ll5bvsov
<br />0Dplic.nrforapcmt.!bj.cBrh.apllicamto0civilI).nnllyofnorrorcrh.nnvenundr.ddolla^(3500).
<br />I, N ow.er . f rhc oon.ny, or my cnrblsr Pnh was.s N I h.ir sl. olmllcnern'.. will do !h. qod( and rhc srduE is ml
<br />inrok or or.Ed for sL {Sc 7 4,auiftssindPmlssionsC.d.:lh.Coltoclor'sLE.nsel,Dsdodm(.ptlvr.!.osrerol
<br />Ilr pmFny who buil{k or irpmvG iE6q and *r$ &* sch qrlk hrmsclf.r h.rs.lror rh$ush his or h.r o*n.nnl.v.6
<br />nmridcd lhd sucn impmvoxds aE mr inrRl.rl or oriRl tt slc l l ll*.ttr. rh. hrildiu or n pm!.m'r is sld u ilhin L 'nc Fr
<br />ofco.Fld ion. rh. Os F Burn r wdl h.r. rh. huds ofDtorn! riEr lE o' rh. dil nn hrld or i,rFmrc fi. Impd, for rh. nlrrrrE ol
<br />-1.
<br />sowRroath. pmpdy. mcx.lurirclycontmtins {ilh licm*d dyitodoc ro otultoll lh. rmj{l (Sd 7044,Irs'ms
<br />and imf*ir cod.' l h. Conlricloas ticcn* Law .r.d bl .rrly lo an ovn.r olnop.ny rho 6uild! or iolmrca lh.ron,
<br />ond who mnlmcls lor iuch psjftk wnh a cont@ro(s) liccN.d p danr ro rhc (o.'lraclor's Li6!. Ltw).
<br />I amcxedfl !nd., sdrb
<br />WORI(IIR,S' COMPDNSAITON
<br />lEElAEAllO!
<br />I hcrcby.{nrn und.r p.mhy ofpsjury ore oflhc fotlowing delahlio.s:
<br />-l
<br />h.re dnd will minlain o Ccn ificarc otcotr$nr k, s.lf-lnsurc lor wrk.re' conp.n!.lion, .s pmvid.d tu by S..rbn l?00 o f the
<br />L1tn, C6d., f.r rh. pdtolmm. of thc *o* for *ti.h lh. tl.mn ir is.d.
<br />-l h6v. and sill mrinroin so.lcn conp.Blrtun insuBm.. !s requn.d Sy S.crion l?00 ol th. Llt r cd!., lor rn pdo.mrcc of
<br />rht w.rk hr which this pemit is hsed Myworlcrr' comn nslion insmnc. cafti.r ald Plicy numh.r e.:
<br />fLl enrrv rur in r* ncrro,tue orrh. vork ror whrh rnir p.mn b irocn I sh.ll mr .nDlor s.y rcN. in nny dnd
<br />' ;d r" t<@ft {hjd b rh. world @mF.Nahon lawt ofctlifomis. ond agR thll if I ilFuld t com Nbjdl lo ltE
<br />mltd 6n{rNrio! prcvilions of s..lion 1700 ofrh. L!t$r c.d.. I ilElt, fonhw h 6mply silt tl[* povi3i.6
<br />WARNING: lj.ilurc b s$ur. {rrkc* onfrne.rin orvem8e Ls unli*lirl, iMl sh.ll suhlccl !D mPl,De. k' rnnrl P.'rlrG Md
<br />cNn firei up l. onc hundred rhorsand doll.tr ls,0l),ol)0), in rddirn,n ro r1r cosl olc.n{,cnsar,on. ddmtsca as prorntd ror rh.
<br />SccLon 11076., rhc hhor Code, inl.r.d md!troaPy s ids
<br />K,"'.ti ^t-/Q L u
<br />IECI.A8AITAN
<br />I hcEby o,n.n hd.r p@lryofr.rjurylhal I am liened undf fmvision ofch.nld9(commcrcing wilfi SedDn 7000, orr)ilNion 1
<br />oa rhe Busi*s nrd PFf.sio.s C.d., n my licene k in tull fore dd .frd
<br />Ilv(,**".,*(,,
<br />Ki,,,"rl -t-tt2
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />P{rap/Drain Line )
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL ltllllrn lbxy\/./'0/u {zz)
<br />Notes, Remarks Etc.
<br />)
<br />Waste & Vent
<br />POOUSPA
<br />Back Flow Device COIiIBIJCIIO!.IINDTAG.ACINCI
<br />I h.Gny dn n undd r,.Ehy of Dcrlury lh,t fiG i. a ddruclion l.ndinB ar.fty lor tn P.rfotumc otlh. solk ft)r $nich lhh I6nir n
<br />irtucd (s*.30s?. civ c.).
<br />L.ndd sNcmc
<br />-
<br />lrdd .! A&EB'-
<br />AftLlcANLDECLrlsAu0!
<br />I lEEby ifllft und.r D.nihyotDrrjuryon.ofrh. followin8 dcclirolions
<br />D.aFlirion P.rhiri Arh.nN Norificarion l.dchl R.srlarions ( r nl. 40, Pnn6)
<br />-RequEd
<br />1..tr.r of Ndrficarion
<br />| ..nifo dul th. f.ddl dgrlLtiore Bs.dinE db.nos ,.mEI e ({ applisblc lo lhie poj..r.
<br />Ciry
<br />-/.o""'rt-ot -/?
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